Zenker’s diverticulum (ZD) is an uncommon hypopharyngeal pouch that occurs at Killian’s triangle, a weak area between the cricopharyngeus and inferior pharyngeal constrictor muscles. Patients typically present with dysphagia, regurgitation, and halitosis. Z-POEM (Zenker’s peroral endoscopic myotomy) has emerged as a minimally invasive alternative to open surgery since 2016, with known complications including bleeding and perforation. However, vocal fold paralysis (VFP) had never been reported. The recurrent laryngeal nerve (RLN) runs along the tracheoesophageal groove, passes through the inferior constrictor muscle, and travels along the posterior cricopharyngeus—directly adjacent to the diverticulum base, making it anatomically vulnerable during septum division. A 68-year-old male with a 1.7 cm × 1.5 cm ZD underwent uncomplicated Z-POEM. The next day, he developed hoarseness. At one month, laryngoscopy confirmed left vocal fold immobility. He received fat augmentation and voice therapy, with partial mobility recovery at six months.

Z-POEM is generally well-tolerated, but this first-ever reported case of post-Z-POEM VFP establishes a new, rare complication. Mechanisms may include direct thermal/mechanical injury to the RLN, compression from a phlebolith or distended pouch, or endotracheal tube cuff pressure. Given the RLN’s anatomical proximity to the diverticulum base, clinicians should consider preoperative vocal assessment and counsel patients on this emerging risk to ensure informed decision-making. Management follows standard VFP protocols: medialization procedures, voice therapy, and serial follow-up.

The work titled “Vocal Fold Paralysis Following Peroral Endoscopic Myotomy for Zenker’s Diverticula: A Case Report”, was published on Eye & ENT Research (published on March 22, 2026).
DOI: 10.1002/eer3.70034